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Acute myocardial infarction: early CT aspects of myocardial microcirculation obstruction after percutaneous coronary intervention

  • Cardiac
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Abstract

Objective

To evaluate the capabilities of delayed enhanced multidetector CT (DE-MDCT), performed immediately after percutaneous coronary intervention (PCI), in predicting myocardial microvascular obstruction (MVO) formation assessed by delayed enhanced MRI (DE-MRI).

Methods

Thirty-two patients presenting with a primary acute myocardial infarction, successfully recanalised by PCI, underwent a DE-MDCT immediately after PCI and a DE-MRI within 1 week. The left ventricle was split into 64 subsegments, rated as “healthy”, “infarcted” or “MVO” on DE-MRI. Their mean density was measured on DE-MDCT and calculated relative to the patient's mean healthy myocardium density. Hypoenhanced DE-MDCT subsegments, termed “CT early MVO”, were also recorded. Sensitivity and specificity of DE-MDCT for MRI-assessed “MVO” subsegments detection was calculated for mean CT relative density (threshold determined from a ROC analysis), “CT early MVO” and both.

Results

Mean CT relative density was higher in MRI-assessed “MVO” than in “infarcted” and “healthy” subsegments (1.82 ± 0.46, 1.43 ± 0.36 and 1.0 ± 0.13 respectively; P < 0.001) leading to a sensitivity and specificity of 94.3 % and 89.2 % for a cutoff of 1.36. Sensitivity and specificity were respectively 16.9 % and 99.8 % for “CT early MVO” and 95.3 % and 89.3 % when considering the two patterns.

Conclusion

DE-MDCT, performed immediately after PCI, allows for an accurate prediction of MVO formation.

Key Points

• Myocardial microvascular obstruction (MVO) is an important prognostic sequel following myocardial infarction.

• MVO can be accurately predicted by multidector CT (MDCT).

• Both hypo- and hyperenhanced myocardial areas can be analysed by MDCT.

• MDCT may become a useful prognostic tool for acute MI outcome.

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Abbreviations

DE-MDCT:

Delayed enhanced multidetector CT

MVO:

Myocardial microvascular obstruction

PCI:

Percutaneous coronary intervention

DE-MRI:

Delayed-enhanced magnetic resonance imaging

CK:

Creatine kinase

MPR:

Multiplanar reconstruction

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Acknowledgements

We acknowledge Michel Ovize from the Department of Cardiology, Louis Pradel Hospital, Lyon, France, for his help with this manuscript.

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Authors and Affiliations

  1. Department of Radiology, Louis Pradel Hospital, CREATIS, CNRS UMR 5220, INSERM U1044, Lyon, France

    Charles Amanieu, Ingrid Sanchez, Simona Arion, Didier Revel & Philippe Douek

  2. Department of Cardiology, U51, Louis Pradel Hospital, Lyon, France

    Eric Bonnefoy

  3. Department of Radiology, Croix-Rousse Hospital, CREATIS, CNRS UMR 5220, INSERM U1044, Lyon, France

    Loic Boussel

  4. Department of Radiology, Croix-Rousse Hospital, 103, Grande rue de la Croix-Rousse, 69004, Lyon, France

    Loic Boussel

Authors
  1. Charles Amanieu
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  2. Ingrid Sanchez
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  3. Simona Arion
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  4. Eric Bonnefoy
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  5. Didier Revel
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  6. Philippe Douek
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  7. Loic Boussel
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Correspondence to Loic Boussel.

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Amanieu, C., Sanchez, I., Arion, S. et al. Acute myocardial infarction: early CT aspects of myocardial microcirculation obstruction after percutaneous coronary intervention. Eur Radiol 23, 2405–2412 (2013). https://doi.org/10.1007/s00330-013-2853-7

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  • DOI: https://doi.org/10.1007/s00330-013-2853-7

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